Wound Repair and Regeneration最新文献

The purpose of this study was to examine whether polymicrobial infection in bone biopsies is associated with infection relapse following surgery for diabetic foot osteomyelitis. Relapse of infection presents a major challenge in treating diabetic foot osteomyelitis, yet the role of microbiological factors in predicting relapse remains underexplored. We conducted a retrospective analysis of 100 patients treated surgically for diabetic foot osteomyelitis. Bone biopsies were obtained intraoperatively for microbiological and histopathological examination. Relapse was defined as the recurrence of infection in bone or soft tissue necessitating additional surgical intervention or antibiotic therapy. Our findings indicate that soft tissue involvement, rather than polymicrobial infection in bone biopsies, is a significant predictor of relapse, with patients exhibiting soft tissue involvement showing a markedly higher likelihood of relapse. In contrast, polymicrobial growth in bone biopsies was not significantly associated with infection relapse. These results highlight the importance of soft tissue integrity in treatment outcomes and suggest that local tissue damage, rather than microbiological diversity, may play a more critical role in relapse. This study challenges the assumption that polymicrobial infection directly influences relapse risk and raises questions regarding the reliance on wound healing as an indicator of successful infection management. Future studies should focus on refining treatment indicators and exploring comprehensive approaches that address both bone and soft tissue infections to reduce relapse rates and improve patient outcomes.

Opioid analgesics are often used to alleviate pain in rodent models of skin wound injury and repair. However, previous studies have demonstrated that opioids can alter the inflammatory response to injury and subsequent wound healing. The purpose of this study was to determine the impact of different formulations of buprenorphine on mouse behaviour, inflammatory response and wound progression following skin exposure to nitrogen mustard (NM). Administration of either short-acting or long-acting formulations of buprenorphine in conjunction with skin NM exposure resulted in body weight loss, reduced activity and behavioural changes. Both short-acting and long-acting formulations also dampened aspects of the inflammatory response to NM exposure, including reduced levels of the chemokines CCL3 and CXCL2 and reduced accumulation of pro-inflammatory macrophages. The diminished inflammatory response was associated with reduced skin injury assessed both externally and histologically. These results have important implications for the use of opioid analgesics in studies involving vesicant exposure as well as the potential for the use of opioids as a countermeasure after NM exposure.

The incidence of episiotomy in Iran has been reported to be high, resulting in complications such as perineal infection and pain. This study investigates the effects of quince seed mucilage on the healing process and perineal pain. A triple-blinded clinical trial was conducted from October 2023 to August 2024 in Iran, involving 90 primiparous women who were randomly assigned to either the quince gel group or the placebo group for a duration of 14 days, with administration three times daily. The primary outcomes included wound healing and pain, which were evaluated using the REEDA questionnaire and the visual analogue scale. Data analysis was performed utilising SPSS version 25. There were no statistically significant differences found between the groups regarding the REEDA and VAS scores immediately following repair (p > 0.05). However, on day 14, the overall REEDA and VAS scores indicated that wound healing and pain levels in the intervention group were significantly more favourable than those in the control group (p = 0.001 vs. p = 0.002, respectively). This study demonstrates the beneficial impact of quince mucilage on improving wound healing and alleviating pain. The application of this mucilage may facilitate a quicker return to normalcy for mothers.

Keloids are a complex type of scar tissue formed by exaggerated wound healing, characterised by the overgrowth of thick fibrous tissue beyond the original wound boundary. While the crucial relationship between keloid formation and the vascular system has been highlighted, conflicting findings have been reported regarding the characterisation of keloid vasculature. Here, we successfully characterised the detailed three-dimensional (3D) structure of vasculature in keloid tissues using tissue clearing methods combined with 3D imaging. First, we compared two optical tissue clearing methods, the clear, unobstructed brain imaging cocktails and computational analysis and immunolabelling-enabled 3D imaging of solvent-cleared organ protocols, and found the latter to provide greater transparency of keloid scars. We then conducted a detailed 3D vascular analysis using light sheet and confocal fluorescence microscopy. In normal skin, capillary loops and the superficial vascular plexus were located in the papillary layer and at the boundary between the papillary and reticular layers, respectively. However, the density of these vessels was higher in keloid scars than in normal skin. The reticular layer of normal skin exhibited fewer blood vessels. In contrast, keloid scars exhibited significantly thickened dermal reticular layers, with the upper reticular layer showing significantly greater vascularisation. The lower reticular layer of keloid scars also exhibited vertically aligned blood vessels, although their density was lower than in the upper reticular layer. These results indicate that excessive vascularisation is predominantly induced in the papillary and upper reticular layers of keloid scars, which might contribute to keloid pathogenesis. The technique described here has the potential to serve as a crucial template for future pathological analyses of abnormal scars.

Advances in biotechnology have introduced artificial dermis as an alternative to autologous tissue reconstruction. Our group has employed artificial dermis grafting for full-thickness temporal defects to overcome the limitations of traditional reconstructive methods, such as local flaps and skin grafts. This study evaluates the changes in colour matching and the degree of scar contraction following artificial dermis grafting and explores its potential for reconstructing such defects. This retrospective study included 25 patients who underwent artificial dermis grafting after skin cancer excision in the temporal region. Colour differences between the scar and surrounding skin were quantified using dE2000 scores. Scar contraction was assessed by measuring scar areas. These two parameters were evaluated intraoperatively, immediately after wound healing, and at 3, 6, and 12 months post-healing. The dE2000 scores immediately after healing and at 3, 6, and 12 months were 15.4 ± 7.4, 14.9 ± 6.8, 10.4 ± 4.6, and 6.3 ± 2.0, respectively (p < 0.01). According to reference values, the colour mismatch was rated as "fair" until 6 months post-healing and as "very good" at 12 months. The amounts of scar contraction immediately after healing and at 3, 6, and 12 months were 55.3 ± 10.5%, 65.6 ± 8.6%, 32.5 ± 15.9%, and 20.6 ± 14.8%, respectively (p < 0.01). These findings indicate that artificial dermis grafting for full-thickness temporal defects initially leads to significant colour mismatch and scar contraction. However, both parameters improve over time, achieving favourable outcomes within 12 months. Artificial dermis grafting may be a viable option for reconstructing skin and soft tissue defects in the temporal region.

Preventing pressure injuries (PIs) remains the most effective way to reduce their burden. A key element of prevention is the assessment of PI risk. The study aimed to investigate whether guidance documents relevant to the United States (US) advocated for specific risk assessment recommendations. We conducted a systematic review of guidance documents published between 2010 and 2024. Embase, Medline, Cinahl, and four key organisational websites were systematically searched to retrieve relevant articles. Two independent reviewers screened the articles for inclusion. One reviewer extracted the data, and a second reviewer checked all extracted data. Three reviewers assessed the guidance documents quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) tool. A narrative synthesis was used to describe and summarise findings. Six clinical practice guidelines (CPGs) and eight other best practice recommendations were included. The median scores of most AGREE II domains were higher for CPGs compared to other best practice recommendations. Risk assessment was consistently positioned as a critical first step in the prevention of PIs, emphasising its role in identifying at-risk individuals and informing targeted interventions. Although risk assessment was presented as a crucial step in PI risk prevention, there was no clear and unanimous recommendation for a specific risk assessment strategy across all guidance documents, either for the general population or for specific subgroups of patients in US healthcare settings. These findings suggest a need for national consensus on concepts, implementation, and language addressing PI risk assessment.

Full-thickness burn wounds pose significant problems, demanding specialised therapies to avoid complications and promote recovery. Eschar tissue, which forms in response to severe burns, contains viable fibroblasts, which migrate from the surrounding tissue in response to burn injury and exhibit a myofibroblast phenotype. The goal of this study was to characterise eschar-derived fibroblasts and examine their use for engineered in vitro full skin equivalents in comparison to normal dermal fibroblasts, which were harvested from non-injured skin. Microarray analysis indicated that eschar fibroblasts differ from dermal fibroblasts in various biological processes including inflammation, extracellular matrix formation, cell migration and differentiation. Skin equivalents with eschar fibroblasts showed similarities to those generated using normal dermal fibroblasts in terms of epidermis and dermis formation. However, in contrast to dermal fibroblast-based full skin equivalents, eschar fibroblast-based equivalents exhibited macroscopic contractile behaviour. In addition, eschar fibroblasts-based equivalents demonstrated higher alpha-smooth muscle actin expression on mRNA and protein levels. In conclusion, our findings suggest that eschar fibroblasts-based full skin equivalents hold promise as a platform to study burn wound environments as eschar fibroblasts are clinically more relevant fibroblasts and able to mimic certain aspects of the challenging wound environment in vitro.

This meta-analysis aimed to systematically assess and synthesise healing rates within a 12- to 24-week treatment period among patients with diabetic foot ulcers receiving standard-of-care interventions in randomised controlled trials. This meta-analysis included 32 randomised controlled trials conducted between 1996 and 2023, with sample sizes ranging from 9 to 169 patients. A random-effects model was applied to estimate pooled healing and infection rates. Heterogeneity was quantified using the I² statistic, and publication bias was assessed using Egger's test. The results revealed a pooled healing rate of 33.15% with a 95% confidence interval (CI) of 31.18%-35.11% and an average healing time of approximately 50.14 days (standard deviation: 31.10 days). The infection proportion was determined to be 17.4% (95% CI: 12.2%-22.5%). Subgroup analysis indicated marginally higher healing rates in the 'Saline Gauze' group compared to the 'Alginate' group, although the latter exhibited a reduced infection proportion. Sensitivity analysis affirmed the robustness of these findings whereas Egger's test suggested the presence of potential publication bias concerning the healing outcomes. The standard-of-care interventions for diabetic foot ulcers demonstrate limited effectiveness, with only about one-third of patients achieving wound closure. The significant heterogeneity and publication bias observed necessitate a cautious interpretation of these results. The findings highlight the need for advanced wound care strategies and personalised treatment plans to improve outcomes in diabetic foot ulcers management. Future research should focus on conducting high-quality, well-reported randomised controlled trials to better understand effective treatments for DFUs.